Skip navigation

Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis.

Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis.

Moukhtarian, T.R., Cooper, R.E ORCID: 0000-0002-9735-4731, Vassos, E., Moran, P. and Asherson, P. (2017) Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis. European Psychiatry, 44. pp. 198-207. ISSN 0924-9338 (doi:

[img] Other (Accepted manuscript)
32761_COOPER_ Effects_of_stimulants_and_atomoxetine_on_emotional_lability_in_adults.docx - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (755kB)


Background: Emotional lability (EL) is an associated feature of attention-deficit/hyperactivity disorder (ADHD) in adults, contributing to functional impairment. Yet the effect of pharmacological treatments for ADHD on EL symptoms is unknown. We conducted a systematic review and meta-analysis to examine the effects of stimulants and atomoxetine on symptoms of EL and compare these with the effects on core ADHD symptoms.
Methods: A systematic search was conducted on the databases Embase, PsychInfo, and Ovid Medline® and the website. We included randomised, double-blind, placebo-controlled trials of stimulants and atomoxetine in adults aged 18-60 years, with any mental health diagnosis characterised by emotional or mood instability, with at least one outcome measure of EL. All identified trials were on adults with ADHD. A random-effects meta-analysis with standardised mean difference and 95% confidence intervals was used to investigate the effect size on EL and compare this to the effect on core ADHD symptoms.
Results: Of the 3,864 publications identified, nine trials met the inclusion criteria for the meta-analysis. Stimulants and atomoxetine led to large mean weighted effect-sizes for on ADHD symptoms (n=9, SMD=-0.8, 95% CI:-1.07 to -0.53). EL outcomes showed more moderate but definite effects (n=9, SMD=-0.41, 95% CI:-0.57 to -0.25).
Conclusions: In this meta-analysis, stimulants and atomoxetine were moderately effective for EL symptoms, while effect size on core ADHD symptoms was twice as large. Methodological issues may partially explain the difference in effect size. Reduced average effect size could also reflect heterogeneity of EL with ADHD pharmacotherapy responsive and non-responsive sub-types. Our findings indicate that EL may be less responsive than ADHD symptoms overall, perhaps indicating the need for adjunctive psychotherapy in some cases. To clarify these questions, our findings need replication in studies selecting subjects for high EL and targeting EL as the primary outcome.

Item Type: Article
Uncontrolled Keywords: Attention-deficit, hyperactivity disorder, emotional lability, stimulants, atomoxetine, systematic review, meta-analysis.
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > R Medicine (General)
Faculty / Department / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > Department of Psychology, Social Work & Counselling
Last Modified: 13 Jul 2021 13:35
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
Selected for REF2021: None

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics